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Cerebellar Mass Lesion

Mass Lesion of Cerebellum


Presentation

  • Methods: Case analysis and literature review Results: A 45-year-old male with no known significant past medical history presented to emergency department due to an episode of severe headache. Patient denied any other associated symptoms.[neurology.org]
  • Cerebellar liponeurocytoma presenting as multifocal bilateral cerebellar hemispheric mass lesions. Neurol India [serial online] 2017 [cited 2018 Nov 24];65:422-4.[neurologyindia.com]
  • Handbook of Clinical Neurology: Neuro-Oncology, Part I summarizes the present state of scientific and clinical knowledge in the field of neuro-oncology, including information related to diagnostic techniques such as imaging, along with immunology, molecular[books.google.com]
  • Older children also present with truncal ataxia, while infants present with increase in head size. CSF seeding is common at presentation and may result in multifocal disease. Imaging Findings.[aocr.org]
  • They usually present with seizures. Radiographically these tumors often lack edema and have a multinodular appearance. Inner table skull erosion or deformation may be present.[cns.org]
Difficulty Walking
  • […] vestibular dysfunction vertigo, difficulty walking, nystagmus, nausea and vomiting NO dysmetria or ataxia on finger to nose or heel to shin Corticospinal tract dysfunction IPSILATERAL hypotonia & weakness often MISTAKEN for ataxia Impaired proprioception[quizlet.com]
  • walking Fatigue and sleepiness Problems with coordination Neck pain or stiffness Visual problems Treatment The doctor will perform tests to determine if it has spread to the spinal cord.[braintumor.org]
Ataxia
  • ataxia Hydrocephalus [which may damage frontopontine pathways] and lesions within the prefrontal cortex — gait abnormalities similar to truncal ataxia Disorders of the spinal cord — gait abnormalities Truncal Ataxia versus Appendicular Ataxia Truncal[brainaacn.org]
  • Sensory ataxia: The term sensory ataxia is employed to indicate ataxia due to loss of proprioception – the loss of sensitivity to the positions of joint and body parts.[howmed.net]
  • They are often called "ataxias". According to Musselman et al (2014), the prevalence of childhood ataxia is 26/100,000 children. Ataxia is rare compared to cerebral palsy (211/100,00) and autism (620/100,000).[dizziness-and-balance.com]
  • This will be due to ataxia involving the lower extremities (not the truncal ataxia with vermis lesions (see below).[casemed.case.edu]
Tremor
  • ., reach past a target, or fall short of the target) • Tremor . The tremor in cerebellar disorders is an action intention tremor (i.e., it is brought out by voluntary movement).[casemed.case.edu]
  • […] tandem gate (be able to walk one foot after the other) Action/intentional tremor tremor that occurs when limb is in motion lesion of ipsilateral lateral hemisphere Titubation (yes or no "shake) tremor of trunk or head lesion of vermis Essential tremor[quizlet.com]
  • A 66 Year old man finds that he has more difficulty in moving about for the past one year. he is annoyed by a tremor in his hands , but the tremor goes away when he performs routine tasks using his hands.[howmed.net]
  • The Romberg test indicates a proprioceptive lesion and is NOT a test of cerebellar function With midline cerebellar lesions, the patient has difficulty standing with eyes open as well as closed [with these lesions, a peculiar tremor of the trunk or head[brainaacn.org]
  • Location - Parafalcine (arising the meningeal layer between the hemispheres of the brain) Common Symptoms - Seizures, lower extremity weakness, headache, personality changes, dementia, increasing apathy, flattening of affect, unsteadiness, tremor.[neurosurgery.ucla.edu]
Lethargy
  • Headache, confusion, lethargy, brain stem and cerebellar disorders, and seizures are also observed ( 2 , 3 ).[ajnr.org]
  • […] fluid (CSF) May obstruct the fourth ventricle, causing hydrocephalus (water on the brain) Occurs most often in children under the age of ten, but may occur in adults Slightly more common in males than females Symptoms Headaches Early morning vomiting Lethargy[braintumor.org]
  • Symptoms include: Headaches Seizures Nausea and vomiting Irritability Lethargy and drowsiness Personality and mental activity changes Macroencephaly (enlarged head) in infants whose skull bones are not completely fused Coma and death, if left untreated[hopkinsmedicine.org]
  • Acute effects include hair loss (alopecia), nausea, vomiting, lethargy, otitis media and severe cerebral edema. Though some of these effects can be transient, dermatitis, alopecia, and otitis media can persist for months after irradiation (23).[irsa.org]
  • Dysdiadochokinesia/Alternating failure Finger to nose test abnormality Gait disturbance/abnormality Headache Headache improved with position change Headache worse with position change Headache worse with valsalva/Bowel movement Headache/worsened by movement Lethargy[howmed.net]
Cerebellar Sign
  • Causes of cerebellar signs include acoustic neuroma, Friedreich's ataxia, stroke, haemangioma, tumours, multiple sclerosis, chronic alcohol excess and abscess.[patient.info]
  • signs Radiology description Well circumscribed Hyperintense on pre contrast T1 weighted images due to lipid content Heterogeneous contrast enhancement Minimal edema Radiology images Images hosted on other servers : Right cerebellopontine angle mass Right[pathologyoutlines.com]
  • Autoantibodies (paraneoplastic cerebellar degeneration , autoimmune disorders) Structural lesions (strokes, MS, tumors, etc) Inherited cerebellar degenerations Signs & Symptoms Acute ataxia Cerebellar signs Dysarthria Dysdiadochokinesia/Alternating failure[howmed.net]
  • The cerebellum demonstrates functional localization; cerebellar signs often correlate with the location of the cerebellar lesion. 2 The deep cerebellar nuclei have specific deficits when damaged.[clinicalgate.com]
Dysarthria
  • Autoantibodies (paraneoplastic cerebellar degeneration , autoimmune disorders) Structural lesions (strokes, MS, tumors, etc) Inherited cerebellar degenerations Signs & Symptoms Acute ataxia Cerebellar signs Dysarthria Dysdiadochokinesia/Alternating failure[howmed.net]
  • . • Dysarthria . The speech is described a scanning . It is essentially ataxia of speech. Often the pitch or rhythm of the speech will change. Grammar and word usage will still be correct. • Nystagmus .[casemed.case.edu]
  • Patients may also present with ataxic tremor, dysarthria, postural instability, or gait disturbances.[clinicalgate.com]
  • Superficial siderosis Recurrent bleeding on the surface of the brain may cause " superficial siderosis ", which is typified by bilateral sensorineural deafness and cerebellar ataxia with dysarthria and nystagmus (Fishman, 1993).[dizziness-and-balance.com]

Workup

  • Such a workup should include imaging of the chest (via chest x-ray and/or CT scan of the chest) and also CT of the abdomen and pelvis.[clinicalgate.com]
  • Any adult who has a recent onset of seizures, particularly focal seizures, is considered a tumor suspect until adequate neurologic workup proves otherwise. Specific Tumor Types There are many types of tumors that develop intracranially.[dartmouth.edu]
Suppression
  • The lesion showed restricted diffusion and was hypointense on fat suppression sequences. MR spectroscopy showed elevated lipid and lactate peaks. Multiple similar smaller lesions were seen in both the cerebellar hemispheres.[neurologyindia.com]
  • MR Findings  TlWI: Sharply-marginated extra-axial fluid collection isointense with CSF  T2WI: Isointense with CSF  FLAIR: Suppresses completely  T2* GRE: No blooming unless hemorrhage present(rare)  DWI: No restriction  T1 C : Doesn't enhance [slideshare.net]
  • […] hyperintense mets from unknown primary seen here Image 1: Variable diffusion characteristics of the non-necrotic components of metastasis (most frequently do not restrict diffusion, as seen on this DWI & corresponding ADC map); necrotic components show suppressed[radcharts.org]
  • […] helpful in tumors such as hemangioblastomas where the cystic component is different from CSF. 6 Tumors with a large percentage of fat-containing substance, such as in cerebellar liponeurocytomas, can be identified by hyperintense streaks on T1, and fat suppression[clinicalgate.com]

Treatment

  • With appropriate diagnosis and treatment, coma can often be treated successfully. Conversely, delay in diagnosis and treatment may be lethal. This monograph provides an update on the clinical approach that was laid out in the previous 3 editions.[books.google.com]
  • Furthermore, the book explains the neurological complications of systemic cancer and complications from treatments.[books.google.com]
  • Cerebellar liponeurocytoma with high proliferation index: Treatment options. Can J Neurol Sci 2009;36:658-61. 7. Cacciola F, Conti R, Taddei GL, Buccoliero AM, Di Lorenzo N. Cerebellar liponeurocytoma.[neurologyindia.com]
  • Surgery is the standard treatment.[braintumor.org]
  • Clinical Programs & Services Medical and surgical care for brain tumors with a patient-focused approach Advanced treatment for strokes, aneurysms and related conditions Nonsurgical and surgical treatment for a wide variety of spinal issues Specialized[braintumortreatment.com]

Prognosis

  • It then describes the emergency treatment, both medical and surgical, of patients with specific disorders of consciousness and their prognosis.[books.google.com]
  • Case report with considerations on prognosis and management. Acta Neurochir 2002;144:829-33. [Figure 1] , [Figure 2][neurologyindia.com]
  • Brain Lesions Prognosis Because of the many different types of brain lesions, the prognosis and outcomes of brain lesions are variable.[emedicinehealth.com]
  • These tumors generally have a good prognosis after surgical resection with an 85% to 100% 5-year survival rate. 1, 9, 10 The favorable prognosis in these patients has been attributed to the low-grade nature of cerebellar pilocytic astrocytomas and the[clinicalgate.com]

Etiology

  • A follow up imaging and investigation for other etiologies are critical. Disclosure: Dr. Tantikittichaikul has nothing to disclose. Dr. Ruthirago has nothing to disclose. Dr. Ali has nothing to disclose. Dr. Claudio has nothing to disclose. Dr.[neurology.org]
  • A wide range of etiologies may present as cerebral multiple ring-enhancing lesions. 2 Cerebral toxoplasmosis in a patient leads to diagnosis of AIDS Alireza Soleimani,Amir Bairami Asian Pacific Journal of Tropical Disease. 2015; 5(8): 667 3 Rare appearance[jpgmonline.com]
  • Besides the clinical course, intraoperative findings and CT or MRI data are evaluated and discussed considering possible etiological hypotheses.[thieme-connect.com]
  • Etiology  From embryonic endoderm, not neuroectoderm![slideshare.net]
  • Clinical Clues to Nonmalignant Brain Lesions Clinical clues Suggested etiology Abnormalities found on more extensive imaging that are suggestive of an etiology Cysticercosis, fungal infections, sarcoidosis, tuberculosis Chronic fever; recent dental procedure[aafp.org]

Epidemiology

  • Divided into eight sections encompassing 61 chapters, the book begins with an overview of the basic principles of tumors, including the epidemiology of primary central nervous system tumors, angiogenesis and invasion in cancer, the link between blood-brain[books.google.com]
  • Clinical and epidemiological research Tumour-like mass lesion: an under-recognised presentation of primary angiitis of the central nervous system E S Molloy 1 , A B Singhal 2 , L H Calabrese 1 1 Department of Rheumatic and Immunologic Diseases, Cleveland[ard.bmj.com]
  • Epidemiologic studies conducted since the introduction of HAART suggest a decline in the incidence of PCNSL in the AIDS population.[ajnr.org]
  • […] neurolipocytoma, medullocytoma, lipomatous glioneurocytoma First reported in 1978 ( Acta Neuropathol 1978;41:261 ) Considered a mixed neuronal - glial tumor; lipid is apparently due to tumoral lipidization, not adipose metaplasia ( Am J Surg Pathol 2001;25:1551 ) Epidemiology[pathologyoutlines.com]
  • Epidemiology  1% of all astrocytomas  Rare but important cause of temporal lobe epilepsy WHO grade II Age  Tumor of children/young adults  Typically first three decades  2/3 18 years Gender: No gender predominance 86.[slideshare.net]
Sex distribution
Age distribution

Pathophysiology

  • The book begins with a description of the physiology of consciousness and the pathophysiology of disorders of consciousness.[books.google.com]
  • Elderly Nystagmus Nystagmus, pendular Short term memory loss Slow speech Staggering Gait Tic syndrome in a child Habit spasm Tremor Tremor,coarse Unable to tandem walk/straight line Vertigo Macrocephaly/Large head Megalocephaly Walking difficulties PATHOPHYSIOLOGY[howmed.net]

Prevention

  • How to Prevent Brain Lesions In some instances, certain brain lesions can be prevented, though not all types can be completely prevented.[emedicinehealth.com]
  • Measures such as neck compression (tourniquet) and volume loading can be helpful in preventing VAE. PEEP increases the risk of VAE.[openanesthesia.org]
  • Radiation After surgery, radiation therapy is used to kill leftover tumor cells and try and prevent recurrence.[braintumor.org]
  • We have not found that WBRT leads to a survival benefit nor that it prevents later onset of remote metastases in other brain locations.[irsa.org]
  • Gross total resection and radiation are the most important factors in preventing recurrence, and primary adjuvant chemotherapy has not been shown to have a significant association with survival. 33, 34 However, for high-risk patients, it appears that[clinicalgate.com]

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